Eric Topol's tough prescription for improving medicine

Eric Topol, M.D., cardiologist at Scripps Health and director of the Scripps Translational Science Institute, holds the Vscan, a pocket sized ultrasound devise, to look at the heart not much bigger than some cell phones.
— Howard Lipin

Eric Topol, M.D., cardiologist at Scripps Health and director of the Scripps Translational Science Institute, holds the Vscan, a pocket sized ultrasound devise, to look at the heart not much bigger than some cell phones.
— Howard Lipin

Word spread quickly last October when a man began suffering chest pains during a cross-country flight. Was there a doctor on the plane? Could anyone help?

A tall figure rose from seat 6C. It was Eric Topol of La Jolla, one of the most respected cardiologists in the country. And he was specially equipped for such an emergency. Topol attached a small, wireless electrocardiogram to his iPhone and determined that the passenger was having a heart attack.

The pilot made an emergency landing, and the man was soon receiving the care he needed.

It was a gratifying moment for Topol, chief academic officer for Scripps Health. He’s a nationally known evangelist for wireless medicine.

But there was also frustration. As the digital revolution rages on, potentially life-saving tools such as hand-held electrocardiograms are not in widespread use.

Topol wrote "The Creative Destruction of Medicine" to take his case for wearable sensors and individualized care to the public. Basic Books

+Read Caption

Topol wrote "The Creative Destruction of Medicine" to take his case for wearable sensors and individualized care to the public.

“There’s no group more resistant to change than medicine,” said Topol, whose frustration led him to quote Voltaire: “Doctors prescribe medicine of which they know little, to cure disease of which they know less, in human beings of which they know nothing.”

Topol also went on to write “The Creative Destruction of Medicine,” a consumer-oriented book on “digital doctoring” that experts cite as fresh evidence that Topol is among the most farsighted, tough-minded and gifted communicators in modern medicine.

The book presses physicians to embrace the use of small, wearable, wireless biosensors that do everything from monitoring glucose levels in diabetics to checking the blood pressure of people with heart disease. The data is sent to smartphones and, in many cases, relayed to health-care providers.

Eric Topol, M.D., cardiologist at Scripps Health and director of the Scripps Translational Science Institute, with a echocardiogram of the heart projected on his body. — Howard Lipin

+Read Caption

Eric Topol, M.D., cardiologist at Scripps Health and director of the Scripps Translational Science Institute, with a echocardiogram of the heart projected on his body.
— Howard Lipin

Topol also wants physicians to get schooled in genetics, a field that has gone mainstream. For example, consumers can send a saliva sample to a company like 23andMe and get a limited look at potential gene-based health threats in two to three weeks. And the cost of having an entire genome sequenced is expected to fall below $1,000 this year.

He has many high-profile supporters, including Greg Lucier, chief executive of Life Technologies, a Carlsbad-based life-sciences company.

“Eric’s commitment to providing state-of-the-art care for patients, using the best tools to solve diseases, keeps him at the forefront of medicine,” Lucier said. “His courage to look at the status quo and advocate for change for the benefit of patients will benefit us all.”

Lucier was referring, in part, to the public battle Topol got into about a decade ago with drugmaker Merck. Topol was the main author of a scientific paper claiming that Merck’s painkiller Vioxx increased patients’ risk of heart attack and stroke. More studies followed from various doctors backing the claim, and Merck was forced to remove the medication from the market. The action came long after Merck challenged Topol’s findings and, in doing so, his reputation.

“It was the most difficult period in my life,” said Topol, who has a boyish face with deep-set eyes and a bright, “aw-shucks” smile.

The clash hasn’t quieted Topol. He can be blunt, and he’s known as a provocateur.

When former Vice President Dick Cheney received a heart transplant in March, Topol posted a message on Twitter saying the operation would raise questions with ethicists. Topol, whom President George W. Bush considered for the post of Food and Drug Administration commissioner in 2005 — was flooded with hate mail.

Eric Topol, M.D., cardiologist at Scripps Health and director of the Scripps Translational Science Institute, uses the Vscan, a pocket sized ultrasound devise not much bigger than some cell phones, to look at the heart during an exam with heart patient Michael Shade of Granbury, Texas.
— Howard Lipin

Eric Topol, M.D., cardiologist at Scripps Health and director of the Scripps Translational Science Institute, uses the Vscan, a pocket sized ultrasound devise not much bigger than some cell phones, to look at the heart during an exam with heart patient Michael Shade of Granbury, Texas.
— Howard Lipin

His criticism of physicians also has caused a lot of cringing in the medical community, where he’s too famous to ignore. He has helped develop life-saving drugs, including the blood thinner Plavix. He led the Cleveland Clinic’s renowned cardiology department to even greater heights. He started a medical school in Cleveland and came close to doing the same at The Scripps Research Institute.

In April, a pair of major health-industry magazines named Topol the most influential physician executive in the country, placing him ahead of the director of the U.S. Centers for Disease Control and Prevention.

He deserves such recognition, said Atul Gawande, a famed surgeon in Boston and writer of medical stories for the New Yorker.

“(Topol has) a great knack for recognizing crucial, often unexpected, issues of great importance to people’s lives — whether in his scientific work or in his public advocacy,” Gawande said.

Topol also is known for his energy, work ethic and love of gadgets. He hasn’t had a long vacation in four years. He walks so fast that he often leaves friends trailing the heels of his size 11½ Ecco loafers. It wouldn’t be unusual to find him at home in Bird Rock, holding an iPhone in one hand and an iPad in the other.

He’s got a rich sense of humor: He quietly desires to hawk his book on “The Colbert Report” to get a funny beat-down from Stephen Colbert. And he’s a data junkie.

“I love information. I can never get enough. I get bored easily,” Topol said.

He struggled to explain his nature on a recent afternoon while sitting in his tidy office, overlooking the 10th green at the Torrey Pines Golf Course.

At first he spread his hands as if to say, “I don’t know.” Then he said, “The drive to change a field, to do something more grand ... I don’t know where that came from. The (saying) ‘thinking big, acting bigger,’ that’s always been me.”

His drive is tied to his personal life.

Topol, who grew up on Long Island, N.Y., lost relatives to cancer when he was young. His mother, a smoker, later died of cancer. His father passed away of diabetes. The 6’, 3” Topol is healthy, although a partial analysis of his genome shows he has a heightened risk of developing Alzheimer’s disease. He takes a statin because there’s some evidence that it can help hold off Alzheimer’s.

Exposure to illness steered Topol into medicine, research and technology. As an undergraduate at the University of Virginia, he worked the night shift at the campus hospital servicing ventilators in the intensive care unit.

“What I saw was really sick people getting better,” Topol said. “All I had prior to that was watching my relatives die. That was a real inflection point for me. I decided I wanted to go to medical school.”

He was equally interested in the emerging field of genetics and wrote an undergraduate senior thesis titled, “Prospects for Genetic Therapy in Man.” The paper, pecked out on a Selectric typewriter in 1975, turned out to be an insightful overview of where the field stood and how genetics might someday be used to identify and fix inherited diseases. He wrote it two years before British biochemist Frederick Sanger developed the first comparatively fast and efficient way to sequence DNA. The discovery earned Sanger the Nobel Prize.

Topol at TEDMED

Extraordinary technical and medical advances were unfolding as Topol went off to medical school at the University of Rochester. The innovations included the first cell phones and personal computers, devices that would propel the digital revolution he now promotes. Medicine was also moving past the mistaken belief that blood clots were not a primary cause of heart attacks.

Topol helped pushed the field forward during his fellowship at Johns Hopkins University, becoming the first doctor to a give a human patient the drug t-PA, which proved very successful at breaking down blood clots.

He also learned what it’s like to be slapped down when proposing change. At Johns Hopkins, he helped introduce a probe that gave surgeons a much clearer look at the heart during operations. He gave a talk about the probe at a conference, only to be cut down by Bernadine Healy, a Johns Hopkins professor who later became director of the National Institutes of Health.

“She said, ‘That’s nice, Eric, but it is a tool in search of a question.’ ... I was ready to quit my fellowship that day,” Topol said.

He later left Johns Hopkins to join the faculty at the University of Michigan, where he helped develop Angiomax and some of the clinical trials that led the Food and Drug Administration to approve Plavix, a drug that rang up $9 billion in worldwide sales last year.

Topol had become a star researcher, and in 1991, at age 36, was named chairman of cardiology at the Cleveland Clinic, one of the world’s top-ranked cardiac centers. He founded the first cardiovascular gene bank, which has helped identify genes associated with heart disease. And he helped persuade the Lerner family to donate $100 million so he could found a medical school there.

He didn’t hit trouble until 2001, when he challenged Merck about the safety of Vioxx.

“If you take on big pharma, they’ll try to humiliate you,” said cardiologist Kanu Chatterjee, Topol’s mentor at UC San Francisco. “I vividly remember that people made jokes about him. But Eric was right about Vioxx. He was right from the start.”

In 2006, Topol accepted an offer to become chief academic officer at Scripps Health and to establish and direct the Scripps Translational Science Institute, which, among other things, studies medical devices.

The six years since then have been a time of success and setbacks.

Topol said he was asked to draw up plans for a small medical school at The Scripps Research Institute that would focus heavily on training doctors in emerging technologies and genetics. He helped get local philanthropists Gary and Mary West to invest $100 million for the project. But the overall plan was eventually turned down. Richard Lerner, the institute’s president at the time, declined to discuss what happened.

West said in an email: “This was a missed opportunity for both the medical community and San Diego. A futuristic and innovative medical school with a curriculum that trains physicians to utilize wireless and other state-of-the-art technologies to provide 21st century medical care at affordable prices is desperately needed.”

Topol and the West family regrouped, and they decided to create the West Wireless Health Institute. Topol envisioned a center that would be used primarily to test emerging medical devices. It hasn’t turned out that way: The institute recently dropped the word “wireless” from its title.

“While wireless plays a crucial role, it is fundamentally an enabling technology (not “THE” solution) and alone will not solve our health care crisis,” West said.

Topol is disappointed, but his quest for new technologies and research goes forward. He landed a $20 million research grant this year. And in March, he published a scientific paper saying that an experimental blood test might be able to provide up to two weeks’ notice that a person is at high risk for experiencing a heart attack. Years of further testing are needed.

Looking ahead, Topol is intent on continuing to push for change. He said as much on a recent Twitter post: “Medicine today is all about averages, medians, population and mass screenings ... unacceptable and antiquated!”

MIlestones in Topol's life

1975: Writes college thesis “Prospects for Genetic Therapy in Man”. He was 20

1984: Gives patient t-PA for first time. t-PA becomes a key drug for breaking down blood clots, a key cause of heart attacks

1997: FDA approves sale of Plavix, a drug Topol helped develop from the first patients in 1989. Plavix was the top selling drug worldwide in 2011, with $9.1 billion in sales

1997: FDA approves sale of ReoPro, a drug that reduces the chances that a blood clot will form after such coronary artery procedures as angioplasty. Topol played key role in developing the drug

2001: Primary author of influential paper in JAMA that cites safety risks of the painkiller Vioxx. This paper and later work by Topol and others lead Merck to remove Vioxx from the market in 2004

2002: Founds the Cleveland Clinic Lerner College of Medicine. He helps secure a $100 million donation from the Lerner family to create the college.

2004: Elected to the elite Institute of Medicine

2006: Scripps Health in La Jolla recruits Topol to be chief academic officer of the health system and to lead the newly created Scripps Genomic Medicine program. He also becomes professor of genomics at The Scripps Research Institute and a joint program in translational science with Scripps Health.

2007: The Scripps Research Institute asks Topol to create a small medical school, but decides against the idea the following year

2007: Topol initiates the Wellderly Study, the first major search for the genetic underpinnings of healthy aging. All patients are 80 and above.

2008: The National Institutes of Health delivers a $20 million Clinical and Translational Science Award to the Scripps Translational Science Institute, a collaboration of Scripps Health and The Scripps Research Institute that is directed by Topol. It’s the first time the prestigious grant has gone to a San Diego area research center.

2009: Topol is featured as one of 11 “Rock Stars of Science” in a GQ Magazine spread that pairs the researchers with top pop music artists

2009: Topol co-founds the West Wireless Health Institute in La Jolla, largely with $100 million in support from philanthropists Gary and Mary West

2012: Topol publishes study that shows that an experimental blood test might be able to give up to two week’s warning that a person is at high risk of suffering a heart attack